Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Jan 15, 2021; 11(1): 27-34
Published online Jan 15, 2021. doi: 10.5495/wjcid.v11.i1.27
Liver transplantation in patients with SARS-CoV-2: Two case reports
Camilla Bezerra Bastos Limeira, Camila Monteiro Veras, José Hicaro Hellano Gonçalves Lima Paiva, Marina Seixas Studart e Neves, Themístocles Mesquita Teles de Carvalho, Natália Stefani de Assunção Ferreira, Alessandra Maria Mont`Alverne Pierre, Ivelise Regina Canito Brasil
Camilla Bezerra Bastos Limeira, Camila Monteiro Veras, Marina Seixas Studart e Neves, Themístocles Mesquita Teles de Carvalho, Alessandra Maria Mont`Alverne Pierre, Ivelise Regina Canito Brasil, Transplantation Division, Hospital Geral de Fortaleza, FORTALEZA 60175742, CE, Brazil
José Hicaro Hellano Gonçalves Lima Paiva, Natália Stefani de Assunção Ferreira, UECE, Uece, FORTALEZA 60175742, Ceara, Brazil
Author contributions: Veras CM and de Assunção Ferreira NS contributed to data collection; Lima Paiva JHHG, Teles de Carvalho TM and Bastos Limeira CB contributed to the drafting of the manuscript and the creation of tables and figure; e Neves MSS, Mont`Alverne Pierre AM and Brasil IRC critically revised and approved the version to be published; all authors have read and approved the manuscript.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: José Hicaro Hellano Gonçalves Lima Paiva, UECE, Uece, Valdetario mota 1121, FORTALEZA 60175742, Ceara, Brazil. hellanohicaro@gmail.com
Received: September 10, 2020
Peer-review started: September 10, 2020
First decision: October 21, 2020
Revised: November 7, 2020
Accepted: November 29, 2020
Article in press: November 29, 2020
Published online: January 15, 2021
Processing time: 125 Days and 1.4 Hours
Abstract
BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). This disease was declared a worldwide health problem with the characteristics of a pandemic. Most patients have mild symptoms and a good prognosis. Information on the evolution and prognosis of COVID-19 in solid organ recipients is scarce.

CASE SUMMARY

We describe two patients who underwent liver transplantation with a positive test result for detection of the viral sequence for COVID-19, using reverse-transcription polymerase chain reaction (RT-PCR), immediately before transplantation. The patients showed good evolution in the postoperative period, without signs of graft dysfunction. The immunosuppressive therapy was not modified. Both patients were discharged for subsequent outpatient follow-up.

CONCLUSION

In conclusion, it is expected that the experience at this center can be used as an example, aimed at the continuation of transplantations by other services and, thus, the morbidity and mortality of patients with liver disease on the transplantation waiting list can be reduced. Transplant centers must be able to readjust daily to the evolution of the COVID-19 pandemic.

Keywords: COVID-19; Liver transplantation; Coronavirus; Pneumonia; Immuno-suppressed patients; Case report; Infection diseases

Core Tip: Coronavirus disease 2019 (COVID-19), caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its consequences have resulted in high rates of morbidity and mortality worldwide in the first half of this year. This infection shows worse outcomes in certain at-risk populations, including those with cirrhosis of any etiology.  Most patients with decompensated cirrhosis have poor quality of life and a high chance of progressing to death if they have high prognostic scores, such as the Model for End-Stage Liver Disease score. The definitive treatment for these patients is liver transplantation. Data related to the evolution and outcome of these patients when infected with SARS-CoV-2, including those undergoing transplantation, are scarce and contributions to the literature on this topic can help the adequate management of these patients, supporting the development of additional research and even guidelines. Thus, the publication of this report on two cirrhotic patients with COVID-19 who underwent liver transplantation is justified.